Objective: The aim of this work is to describe application of a data-driven approach
(bottleneck analysis [BNA] approach process) to accelerate newborn care services in two
regions and what effect it had on national-level newborn care interventions in Ghana.
Study design: A mixed-method approach was used for the study. The BNA tool generated
quantitative data and group discussions provided phenomenological explanations to
identified service gaps.
Methods: Regional newborn care health service assessments were conducted in November
2013 through desk reviews, field and health facility visits and coaching/mentorship. The
BNA tool (an excel-based tool) directly utilized service coverage data and programme
monitoring and review reports in Ghana. Outputs were generated based on service
coverage indicators: supply side/health system factors (commodities, human resource and
access), demand side (service utilization) and quality/effective coverage. National targets
were used as benchmarks to assess gaps in coverage indicators.
Results: Key health system bottlenecks included absence/stock-out of essential newborn
care commodities/resuscitation kits and absence of updated policies at services delivery
points. In both regions, less than 55% of health facilities had at least 80% of midwivestrained to provide essential obstetric and newborn care, management of preterm babies,
resuscitation and inpatient paediatric care. In addition, less than 35% of pregnant women
were assisted by a skilled birth attendant (midwife) and monitored with a partograph in the
two regions. Demand-side bottlenecks included cultural preference for home deliveries,
limited knowledge on importance of postnatal care and poor community involvement.The
BNA approach in the two regions resulted in the development of national and other
regional operational plans and monitoring and evaluation framework for newborn care
services in Ghana over the period 2012e2016, and a relative improvement in neonatal
mortality at the regional and national level.
Conclusion: The BNA tool and approach provided data-driven planning for newborn care
service delivery in a low-income setting. It identified gaps in service coverage based on
empirical data at lower levels of the health system and garnered strategies in addressing
bottlenecks to newborn care services at the national level.